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On May 13, 2011, FDA approved VICTRELIS™ (boceprevir), a hepatitis C virus (HCV) protease inhibitor, which works by binding to the virus and preventing it from multiplying. Boceprevir is the first direct acting antiviral drug against the hepatitis C virus to be approved.
VICTRELIS is indicated for the treatment of chronic hepatitis C genotype 1 infection, in combination with peginterferon alfa and ribavirin, in adult patients (18 years and older) with compensated liver disease, including cirrhosis, who are previously untreated or who have failed previous interferon and ribavirin therapy
The following points should be considered when initiating VICTRELIS for treatment of chronic hepatitis C infection:
• VICTRELIS must not be used as monotherapy and should only be used in combination with peginterferon alfa and ribavirin.
• VICTRELIS efficacy has not been studied in patients who have previously failed therapy with a treatment regimen that includes VICTRELIS or other HCV NS3/4A protease inhibitors.
• VICTRELIS in combination with peginterferon alfa and ribavirin has not been studied in patients documented to be historical null responders (less than a 2-log10 HCV-RNA decline by treatment week 12) during prior therapy with peginterferon alfa and ribavirin. The clinical studies included subjects who were poorly interferon responsive. Subjects with less than 0.5-log10 HCV-RNA decline in viral load at Treatment Week 4 with peginterferon alfa plus ribavirin alone are predicted to have a null response (less than 2-log10 viral load decline at Treatment Week 12) to peginterferon alfa and ribavirin therapy.
• Poorly interferon responsive patients who were treated with VICTRELIS in combination with peginterferon alfa and ribavirin have a lower likelihood of achieving a sustained virologic response (SVR), and a higher rate of detection of resistance-associated substitutions upon treatment failure, compared to patients with a greater response to peginterferon alfa and ribavirin.
DOSAGE AND ADMINISTRATION
VICTRELIS must be administered in combination with peginterferon alfa and ribavirin. The dose of VICTRELIS is 800 mg (four 200-mg capsules) three times daily (every 7-9 hours) with food [a meal or light snack] (see Table 1). Refer to the peginterferon alfa and ribavirin Package Inserts for instructions on dosing.
The following dosing recommendations differ for some subgroups from the dosing studied in the Phase 3 trials. Response-Guided Therapy (RGT) is recommended for most individuals, but longer dosing is recommended in targeted subgroups (e.g., patients with cirrhosis).
VICTRELIS Combination Therapy: Patients Without Cirrhosis Who Are Previously Untreated or Who Are Previous Partial Responders or Relapsers to Interferon and Ribavirin therapy
• Initiate therapy with peginterferon alfa and ribavirin for 4 weeks (Treatment Weeks 1-4).
• Add VICTRELIS 800 mg (four 200-mg capsules) orally three times daily (every 7-9 hours) to peginterferon alfa and ribavirin regimen after 4 weeks of treatment. Based on the patient's HCV-RNA levels at Treatment Week (TW) 8, TW12 and TW24, use the following Response-Guided Therapy (RGT) guidelines to determine duration of treatment (see Table 1).
Table 1
Duration of Therapy Using Response-Guided Therapy (RGT) Guidelines in Patients Without Cirrhosis Who Are Previously Untreated or Who Are Previous Partial Responders or Relapsers to Interferon and Ribavirin Therapy
Table 1
Duration of Therapy Using Response-Guided Therapy (RGT) Guidelines in Patients Without Cirrhosis Who Are Previously Untreated or Who Are Previous Partial Responders or Relapsers to Interferon and Ribavirin
Therapy
|
|
ASSESSMENT* (HCV-RNA Results†) |
RECOMMENDATION |
|
|---|---|---|---|
|
|
At Treatment Week 8 |
At Treatment Week 24 |
|
|
Previously Untreated Patients |
Undetectable |
Undetectable |
Complete three-medicine regimen at TW28. |
|
Detectable |
Undetectable |
1. Continue all three medicines and finish
through TW36; and then 2. Administer peginterferon alfa and ribavirin
and finish through TW48. |
|
|
Previous Partial Responders or Relapsers |
Undetectable |
Undetectable |
Complete three-medicine regimen at TW36. |
|
Detectable |
Undetectable |
1. Continue all three medicines and finish
through TW36; and then 2. Administer peginterferon alfa and ribavirin
and finish through TW48. |
|
|
*TREATMENT FUTILITY If the patient has HCV-RNA results greater than or equal to 100 IU/mL at TW12, then discontinue three-medicine regimen.
† In clinical trials, HCV-RNA in plasma was measured using a Roche COBAS® TaqMan® assay with a lower limit of quantification of 25 IU/mL and a limit of detection of 9.3 IU/mL. See Warnings and Precautions (5.5) for a description of HCV-RNA assay recommendations. |
|||
Response-Guided Therapy was not studied in subjects who had less than a 2-log10 HCV-RNA decline by treatment week 12 during prior therapy with peginterferon alfa and ribavirin. If considered for treatment, these subjects should receive 4 weeks of peginterferon alfa and ribavirin followed by 44 weeks of VICTRELIS 800 mg orally three times daily (every 7-9 hours) in combination with peginterferon alfa and ribavirin. In addition, consideration should be given to treating previously untreated patients who are poorly interferon responsive (as determined at TW4) with 4 weeks peginterferon alfa and ribavirin followed by 44 weeks of VICTRELIS 800 mg orally three times daily (every 7-9 hours) in combination with peginterferon alfa and ribavirin in order to maximize rates of SVR [see Clinical Studies (14)].
VICTRELIS Combination Therapy: Patients with Cirrhosis
Patients with compensated cirrhosis should receive 4 weeks peginterferon alfa and ribavirin followed by 44 weeks VICTRELIS 800 mg (four 200-mg capsules) three times daily (every 7-9 hours) in combination with peginterferon alfa and ribavirin.
Dose Modification
Dose reduction of VICTRELIS is not recommended.
If a patient has a serious adverse reaction potentially related to peginterferon alfa and/or ribavirin, the peginterferon alfa and/or ribavirin dose should be reduced or discontinued. Refer to the peginterferon alfa and ribavirin Package Inserts for additional information about how to reduce and/or discontinue the peginterferon alfa and/or ribavirin dose. VICTRELIS must not be administered in the absence of peginterferon alfa and ribavirin.
Discontinuation of Dosing Based on Treatment Futility
Discontinuation of therapy is recommended in all patients with 1) HCV-RNA levels of greater than or equal to 100 IU/mL at TW12; or 2) confirmed detectable HCV-RNA levels at TW24.
CLINICAL TRIAL RESULTS
The approval of Victrelis is based on safety and efficacy data in approximately 1500 adult subjects who were previously untreated (SPRINT-2) or who had failed previous peginterferon alfa and ribavirin therapy (RESPOND-2) in Phase 3 clinical studies
Previously Untreated Subjects
SPRINT-2 was a randomized, double-blind, placebo-controlled study comparing two therapeutic regimens of VICTRELIS 800 mg orally three times daily in combination with PR [PegIntron 1.5 µg/kg/week subcutaneously and weight-based dosing with REBETOL (600-1400 mg/day orally divided twice daily)] to PR alone in adult subjects who had chronic hepatitis C (HCV genotype 1) infection with detectable levels of HCV-RNA and were not previously treated with interferon alfa therapy. Subjects
were randomized in a 1:1:1 ratio within two separate cohorts (Cohort 1/non-Black and Cohort 2/Black) and were stratified by HCV genotype (1a or 1b) and by HCV-RNA viral load (=400,000 IU/mL vs. >400,000 IU/mL) to one of the following three treatment arms:
- PegIntron + REBETOL for 48 weeks (PR48).
- PegIntron + REBETOL for four weeks followed by VICTRELIS 800 mg three times daily + PegIntron + REBETOL for 24 weeks. The subjects were then continued on different regimens based on Treatment Week (TW) 8 through TW24 response-guided therapy (VICTRELIS-RGT). All subjects in this treatment arm were limited to 24 weeks of therapy with VICTRELIS.
- Subjects with undetectable HCV-RNA at TW8 (early responders) and who were also negative through TW24 discontinued therapy and entered follow-up at the TW28 visit.
- Subjects with detectable HCV-RNA at TW8 or any subsequent treatment week but subsequently negative at TW24 (late responders) were changed in a blinded fashion to placebo at the TW28 visit and continued therapy with PegIntron + REBETOL for an additional 20 weeks, for a total treatment duration of 48 weeks.
- PegIntron + REBETOL for four weeks followed by VICTRELIS 800 mg three times daily + PegIntron + REBETOL for 44 weeks (VICTRELIS-PR48).
All subjects with detectable HCV-RNA in plasma at TW24 were discontinued from treatment. Sustained Virologic Response (SVR) was defined as plasma HCV-RNA undetectable at Follow-up Week 24. Plasma HCV-RNA results at Follow-up Week 12 were used if plasma HCV-RNA results at Follow-up Week 24 were missing.
Mean age of subjects randomized was 49 years. The racial distribution of subjects was as follows: 82% White, 14% Black, and 4% others. The distribution of subjects by gender was 60% men and 40% women.
The addition of VICTRELIS to PegIntron and REBETOL significantly increased the SVR rates compared to PegIntron and REBETOL alone in the combined cohort (63% to 66% VICTRELIS-containing arms vs. 38% PR48 control) for randomized subjects who received at least one dose of any study medication (Full-Analysis-Set population). SVR rates for Blacks in a predefined analysis who received the combination of VICTRELIS with PegIntron and REBETOL were 42% to 53% (see Table 10).
Table 10
Sustained Virologic Response (SVR)*, † and Relapse Rates‡ for Previously Untreated Subjects
|
Study Cohorts |
VICTRELIS-RGT |
VICTRELIS-PR48 |
PR48 |
|---|---|---|---|
|
Cohort 1 Plus Cohort 2 (all subjects) |
n=368 |
n=366 |
n=363 |
|
SVR† % |
63 |
66 |
38 |
|
Relapse‡ % (n/N) |
9 (24/257) |
9 (24/265) |
22 (39/176) |
|
Cohort 1 Plus Cohort 2 (subjects without cirrhosis) |
|
|
|
|
SVR†,§ % (n/N) |
65 (228/352) |
68 (232/342) |
38 (132/350) |
|
Cohort 1 (non-Black) |
n=316 |
n=311 |
n=311 |
|
SVR† % |
67 |
68 |
40 |
|
Relapse‡ % (n/N) |
9 (21/232) |
8 (18/230) |
23 (37/162) |
|
Cohort 2 (Black) |
n=52 |
n=55 |
n=52 |
|
SVR† % |
42 |
53 |
23 |
|
Relapse‡ % (n/N) |
12 (3/25) |
17 (6/35) |
14 (2/14) |
|
*The Full Analysis Set (FAS) consisted of all randomized subjects (N=1097) who received at least one dose of any study medication (PegIntron, REBETOL, or VICTRELIS). †Sustained Virologic Response (SVR): reported as plasma HCV-RNA < 25 IU/mL at follow-up week (FW) 24. The last available HCV-RNA value in the period at
or after FW24 was used. If HCV-RNA value at FW24 was missing, the FW12 value was carried forward. ‡Relapse rate was the proportion of subjects with undetectable HCV-RNA at End of Treatment (EOT) and detectable HCV-RNA (≥ 25 IU/mL) at End of Follow-up (EOF) among subjects who were undetectable at EOT and not missing End of Follow-up (EOF) data. §Includes subjects with missing baseline data regarding cirrhosis as diagnosed by liver biopsy. |
|||
Sustained Virologic Response (SVR) Based on TW8 HCV-RNA Results
Table 11 presents sustained virologic response based on TW8 HCV-RNA results in previously untreated subjects. Fifty-seven percent (208/368) of subjects in the VICTRELIS-RGT arm and 56% (204/366) of subjects in the VICTRELIS-PR48 arm had undetectable HCV RNA at TW8 (early responders) compared with 17% (60/363) of subjects in the PR48 arm.
Table 11
Sustained Virologic Response (SVR) by HCV-RNA Detectability at TW8 in Previously Untreated Subjects in the Combined Cohort
|
|
VICTRELIS-RGT |
VICTRELIS-PR48 |
PR48 |
|---|---|---|---|
|
SVR by TW8 Detectability, % (n/N)* |
N=337 |
N=335 |
N=331 |
|
Undetectable |
88 (184/208) |
90 (184/204) |
85 (51/60) |
|
Detectable |
36 (46/129) |
40 (52/131) |
30 (82/271) |
|
*Denominator included only subjects with HCV-RNA results at TW8. |
|||
Among subjects with detectable HCV-RNA at TW8 who had attained undetectable HCV-RNA at TW24 and completed at least 28 weeks of treatment, the SVR rates were 66% (45/68) in VICTRELIS-RGT arm (4 weeks of PegIntron and REBETOL then 24 weeks of VICTRELIS with PegIntron and REBETOL followed by 20 weeks of PegIntron and REBETOL alone) and 75% (55/73) in VICTRELIS-PR48 arms (4 weeks of PegIntron and REBETOL then 44 weeks of VICTRELIS with PegIntron and REBETOL).
Subjects Who Failed Previous Therapy with Peginterferon Alfa and Ribavirin
RESPOND-2 was a randomized, parallel-group, double-blind study comparing two therapeutic regimens of VICTRELIS 800 mg orally three times daily in combination with PR [PegIntron 1.5 µg/kg/week subcutaneously and weight-based ribavirin (600-1400 mg/day orally divided twice daily)] compared to PR alone in adult subjects with chronic hepatitis C (HCV genotype 1) infection with demonstrated interferon responsiveness (as defined historically by a decrease in HCV-RNA viral load greater
than or equal to 2-log10 by Week 12, but never achieved SVR [partial responders] or undetectable HCV-RNA at end of prior treatment with a subsequent detectable HCV-RNA in plasma [relapsers]). Subjects with less than 2-log10 decrease in HCV-RNA by week 12 of previous treatment (prior null responders) were not eligible for enrollment in this trial. Subjects were randomized in a 1:2:2 ratio and stratified based on response to their previous qualifying regimen (relapsers vs. partial
responders) and by HCV subtype (1a vs. 1b) to one of the following treatment arms:
- Subjects with undetectable HCV-RNA at TW8 (early responders) and TW12 completed therapy at TW36 visit.
- Subjects with a detectable HCV-RNA at TW8 but subsequently undetectable at TW12 (late responders) were changed in a blinded fashion to placebo at the TW36 visit and continued treatment with PegIntron + REBETOL for an additional 12 weeks, for a total treatment duration of 48 weeks.
All subjects with detectable HCV-RNA in plasma at TW12 were discontinued from treatment. Sustained Virologic Response (SVR) was defined as plasma HCV-RNA undetectable at Follow-up Week 24. Plasma HCV-RNA results at Follow-up Week 12 were used if plasma HCV-RNA results at Follow-up Week 24 were missing.
Mean age of subjects randomized was 53 years. The racial distribution of subjects was as follows: 85% White, 12% Black, and 3% others. The distribution of subjects by gender was 67% men and 33% women.
The addition of VICTRELIS to the PegIntron and REBETOL therapy significantly increased the SVR rates compared to PegIntron/REBETOL alone (59% to 66% VICTRELIS-containing arms vs. 23% PR48 control) for randomized subjects who received at least one dose of any study medication (Full-Analysis-Set population) (see Table 12).
Table 12
Sustained Virologic Response (SVR)*, † and Relapse‡ Rates for Subjects Who have Failed Previous Therapy with Peginterferon Alfa and Ribavirin
|
|
VICTRELIS-RGT |
VICTRELIS-PR48 |
PR48 |
|
|---|---|---|---|---|
|
|
N=162 |
N=161 |
N=80 |
|
|
SVR† % |
59 |
66 |
23 |
|
|
Relapse‡ % (n/N) |
14 (16/111) |
12 (14/121) |
28 (7/25) |
|
|
SVR (subjects without cirrhosis) § (n/N) |
62 (90/145) |
65 (90/139) |
26 (18/70) |
|
|
SVR by Response to Previous Peginterferon and Ribavirin Therapy |
||||
|
Previous Response |
Relapser, % (n/N) |
70 (73/105) |
75 (77/103) |
31 (16/51) |
|
Partial responder, % (n/N) |
40 (23/57) |
52 (30/58) |
7 (2/29) |
|
|
*The Full Analysis Set (FAS) consisted of all randomized subjects (N=403) who received at least one dose of any study medication (PegIntron, REBETOL, or VICTRELIS). †Sustained Virologic Response (SVR): reported as plasma HCV-RNA < 25 IU/mL at follow-up week (FW) 24. The last available HCV RNA value in the period at or after FW24 was used. If HCV RNA
value at FW24 was missing, the FW12 value was carried forward. ‡Relapse rate was the proportion of subjects with undetectable HCV-RNA at End of Treatment (EOT) and detectable HCV-RNA (≥ 25 IU/mL) at End of Follow-up (EOF) among subjects who were undetectable at EOT and not missing End of Follow-up (EOF) data. § Includes subjects with missing baseline data regarding cirrhosis as diagnosed by liver biopsy. Previous Partial Responder = subject who failed to achieve SVR after at least 12 weeks of previous treatment with PegIntron/REBETOL, but demonstrated a ≥2-log10 reduction in HCV-RNA by Week 12. Previous Relapser = subject who failed to achieve SVR after at least 12 weeks of previous treatment with PegIntron/REBETOL, but had undetectable HCV-RNA at the end of treatment. |
||||
In subjects with cirrhosis at baseline, sustained virologic response was higher in those who received treatment with the combination of VICTRELIS with PegIntron and REBETOL for 44 weeks after 4 weeks of lead-in therapy with PegIntron and REBETOL (17/22, 77%) compared to those who received RGT (6/17, 35%).
Sustained Virologic Response (SVR) Based on TW8 HCV-RNA Results
Table 13 presents sustained virologic response based on TW8 HCV-RNA results in subjects who have failed previous therapy. Forty-six percent (74/162) of subjects in the VICTRELIS-RGT arm and 52% (84/161) in the VICTRELIS-PR48 had undetectable HCV RNA at TW8 (early responders) compared with 9% (7/80) in the PR48 arm.
Table 13
Sustained Virologic Response (SVR) by HCV-RNA Detectability at TW8 in Subjects Who Have Failed Previous Therapy
|
|
VICTRELIS-RGT |
VICTRELIS-PR48 |
PR48 |
|---|---|---|---|
|
SVR by TW8 Detectability, % (n/N)* |
N=146 |
N=154 |
N=72 |
|
Undetectable |
88 (65/74) |
88 (74/84) |
100 (7/7) |
|
Detectable |
40 (29/72) |
43 (30/70) |
14 (9/65) |
|
*Denominator included only subjects with HCV-RNA results at TW8. |
|||
Among subjects with detectable HCV-RNA at TW 8 who attained an undetectable HCV-RNA at TW12 and completed at least 36 weeks of treatment, the SVR rates were 79% (27/34) in VICTRELIS-RGT arm (4 weeks of PegIntron and REBETOL then 32 weeks of VICTRELIS with PegIntron and REBETOL followed by 12 weeks of PegIntron and REBETOL alone) and 72% (29/40) in VICTRELIS-PR48 arm (4 weeks of PegIntron and REBETOL then 44 weeks of VICTRELIS with PegIntron and REBETOL).
Interferon Responsiveness during Lead-In Therapy with Peginterferon alfa and Ribavirin
Previously Untreated Subjects
In previously untreated subjects evaluated in SPRINT-2, interferon-responsiveness (defined as greater than or equal to 1-log10 decline in viral load at TW4) was predictive of SVR. VICTRELIS-treated subjects who demonstrated interferon responsiveness at TW4 achieved SVR rates of 81% (203/252) in VICTRELIS-RGT arm and 79% (200/254) in VICTRELIS-PR48 arm, compared to 52% (134/260) in subjects treated with PegIntron/REBETOL.
VICTRELIS-treated subjects who demonstrated poor interferon responsiveness (defined as less than 1-log10 decline in viral load at TW4), achieved SVR rates of 28% (27/97) in VICTRELIS-RGT arm and 38% (36/95) in VICTRELIS-PR48 arm, compared to 4% (3/83) in subjects treated with PegIntron/REBETOL. Subjects with less than a 0.5-log10 decline in viral load at TW4 achieved SVR rates of 28% (13/47) in VICTRELIS-RGT arm and 30% (11/37) in VICTRELIS-PR48 arm, compared to 0% (0/25) in subjects
treated with PegIntron/REBETOL. Subjects with less than a 0.5-log10 decline in viral load at TW4 with peginterferon alfa plus ribavirin therapy alone are predicted to have a null response (less than 2-log10 viral load decline at TW12) to peginterferon alfa and ribavirin.
Subjects Who Failed Previous Therapy with Peginterferon Alfa and Ribavirin
In subjects who were previous relapsers and partial responders evaluated in RESPOND-2, interferon-responsiveness (defined as greater than or equal to 1-log10 decline in viral load at TW4) was predictive of SVR. VICTRELIS-treated subjects who demonstrated interferon responsiveness at TW4 achieved SVR rates of 74% (81/110) in VICTRELIS-RGT arm and 79% (90/114) in VICTRELIS-PR48 arm, compared to 27% (18/67) in subjects treated with PegIntron/REBETOL. VICTRELIS-treated subjects who
demonstrated poor interferon responsiveness (defined as less than 1-log10 decline in viral load at TW4) achieved SVR rates of 33% (15/46) in VICTRELIS-RGT arm and 34% (15/44) in VICTRELIS-PR48 arm, compared to 0% (0/12) in subjects treated with PegIntron/REBETOL.
CONTRAINDICATIONS
VICTRELIS combination treatment is contraindicated in:
- Pregnant women and men whose female partners are pregnant because of the risks for birth defects and fetal death associated with ribavirin
- Coadministration with drugs highly dependent on CYP3A4/5 for clearance or with potent CYP3A4/5 inducers including the following agents:
- alfuzosin
- carbamazepine, oxcarbazepine, phenobarbital, phenytoin
- rifampin
- Dihydroergotamine, ergonovine, ergotamine, methylergonovine
- Cisapride
- St John’s wort
- Lovastatin, simvastatin
- Drosperinone
- REVATIO® (sildenafil) or ADCIRCA® (tadalafil) when used for the treatment of pulmonary arterial hypertension
- Pimozide
- Triazolam, orally administered midazolam
WARNINGS AND PRECAUTIONS
The Warnings and Precautions for Victrelis include drug interactions and the following:
- Pregnancy (Use with Ribavirin and Peginterferon Alfa)
Ribavirin may cause birth defects and fetal death; avoid pregnancy in female patients and female partners of male patients. Patients must have a negative pregnancy test prior to therapy and have monthly pregnancy test. Systemic hormonal contraceptives may not be as effective in women while taking VICTRELIS. Two alternative effective methods of contraception, including intrauterine devices and barrier methods, should be used in women during treatment with VICTRELIS and concomitant ribavirin.
- Anemia (Use with Ribavirin and Peginterferon Alfa)
Anemia has been reported with peginterferon alfa and ribavirin therapy. The addition of VICTRELIS to peginterferon alfa and ribavirin is associated with an additional decrease in hemoglobin concentrations. Complete blood counts should be obtained pretreatment, and at Treatment Weeks 4, 8, and 12, and should be monitored closely at other time points, as clinically appropriate. If hemoglobin is less than 10 g/dL, a decrease in dosage or interruption of ribavirin is recommended; and if hemoglobin is less than 8.5 g/dL, discontinuation of ribavirin is recommended
- Neutropenia (Use with Ribavirin and Peginterferon Alfa)
In Phase 2 and 3 clinical trials, seven percent of subjects receiving the combination of VICTRELIS with PegIntron/REBETOL had neutrophil counts of less than 0.5 x 109/L compared to 4% of subjects receiving PegIntron/REBETOL alone (see Table 4). Three subjects experienced severe or life-threatening infections associated with neutropenia, and two subjects experienced life-threatening neutropenia while receiving the combination of VICTRELIS with PegIntron/REBETOL. Complete blood count (with white blood cell differential counts) must be conducted in all patients prior to initiating VICTRELIS combination therapy. Complete blood counts should be obtained at Treatment Weeks 4, 8, and 12, and should be monitored closely at other time points, as clinically appropriate. Decreases in neutrophil counts may require dose reduction or discontinuation of peginterferon alfa and ribavirin
- Laboratory Tests
HCV-RNA levels should be monitored at Treatment Weeks 4, 8, 12, and 24, at the end of treatment, during treatment follow-up, and for other time points as clinically indicated. Use of a sensitive real-time reverse-transcription polymerase chain reaction (RT-PCR) assay for monitoring HCV-RNA levels during treatment is recommended. The assay should have a lower limit of HCV-RNA quantification of equal to or less than 25 IU/mL, and a limit of HCV-RNA
detection of approximately 10-15 IU/mL. For the purposes of assessing Response-Guided Therapy milestones, a confirmed “detectable but below limit of quantification” HCV-RNA result should not be considered equivalent to an “undetectable” HCV-RNA result.
Complete blood count (with white blood cell differential counts) must be conducted in all patients prior to initiating VICTRELIS combination therapy. Complete blood counts should be obtained at Treatment Weeks 4, 8, and 12, and should be monitored closely at other time points, as clinically appropriate
ADVERSE DRUG REACTIONS
The most commonly reported adverse reactions (>35% subjects of regardless of investigator's causality assessment) in adult subjects were fatigue, anemia, nausea, headache, and dysgeusia when VICTRELIS was used in combination with PegIntron and REBETOL.
During the four week lead-in period with PegIntron/REBETOL in the VICTRELIS-containing arms, 28/1263 (2%) subjects experienced adverse reactions leading to discontinuation of treatment. During the entire course of treatment, the proportion of subjects who discontinued treatment due to adverse reactions was 13% for subjects receiving the combination of VICTRELIS with PegIntron/REBETOL and 12% for subjects receiving PegIntron/REBETOL alone. Events resulting in discontinuation were similar to those seen in previous studies with PegIntron/REBETOL. Only anemia and fatigue were reported as events that led to discontinuation in >1% of subjects in any arm
USE IN SPECIAL POPULATIONS:
• Cirrhosis: Safety and efficacy has not been studied in patients with decompensated cirrhosis or in patients with an organ transplant. (8.7, 8.10)
• Co-infection with Human Immunodeficiency Virus (HIV): Safety and efficacy has not been established in patients co-infected with HCV and HIV. (8.8)
• Co-infection with Hepatitis B Virus (HBV): Safety and efficacy has not been studied in patients co-infected with HCV and HBV. (8.9)
• Pediatrics: Safety and efficacy has not been studied in pediatric patients. (8.4)
• Ribavirin Pregnancy Registry available
The complete label will be posted soon to the FDA website at Drugs@FDA, an online database where you can find drug labeling and other information related to product approval.
An FDA press release provides additional information about the approval.
Richard Klein
Office of Special Health Issues
Food and Drug Administration
Kimberly Struble
Division of Antiviral Drug Products
Food and Drug Administration
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